Improving Together
Improving Together Issue #7 - October 2019
Diamond Ward Delivery Suite awarded Diamond status in Exemplar programme
WE WILL ROCK FLU Our flu campaign is underway Find out more on pages 5+6
New Chief Executive appointed Louise Barnett will join SaTH early in the New Year - see page 10
Our Quality Improvement journey to delivering great care Caring | Well-Led | Responsive | Effective | Safer
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News in Brief • Infection Prevention and Control - we need to ensure we comply with uniform policy, including being bare below the elbows in clinical areas.
New ultrasound machines The Trust has three new life-saving ultrasound machines for critically ill patients, thanks to a £150,000 donation from The League of Friends of RSH.
• Information Governance - our staff are reminded to ensure notes trolleys are locked; and computers are locked when not in use. • Clutter - please keep clutter to a minimum. As part of plans to keep clutter to a minimum our Kaizen Promotion Office (KPO) team held a 5S events. During the events (pictured), items deemed unnecessary are labelled up and either recycled or disposed of using skips.
Dr Ashley Miller (pictured), Consultant in Intensive Care and Anaesthesia at SaTH, said: “Ultrasound is like having a window into the body so we can directly visualize blood vessels, nerves, the heart, lungs and abdominal organs. In theatre this allows us to place lines into blood vessels and to guide placement of local anaesthetic around nerves under direct vision. “In our Intensive Therapy Units, ultrasound is incredibly useful for many applications. It allows us to see exactly how the heart is working and how treatment strategies affect this. We can see lung disease with much greater accuracy than with a chest x-ray. We can assess all the abdominal organs to look for various diseases. “All this can be done rapidly at the patient’s bedside by the clinician looking after the patient and guide management minute to minute. It is radiation free, avoids the need to transfer critically ill patients and is available 24/7. These machines will save lives.”
Dennis Briggs, chairman of the group (pictured), said: “It’s making life easier for the men who are suffering.The group will now begin its fundraising efforts again to purchase another piece of equipment for the hospital. Improving patient experience They are unsure what it will be, they are happy to provide the money for another life-improving SaTH is developing a new committee to piece of equipment. improve experience for patients regardless of their background. The Trust is looking for members of the public to join staff from the Mock CQC inspections Trust on its new Equality, Diversity and Inclusivity sub-committee.
Ruth Smith, Lead for Patient Experience at SaTH, said: “We want to make sure everyone at SaTH has a great patient experience, regardless of age, disability, gender reassignment, race, religion or belief, sex, sexual orientation, marriage or civil partnership status, or pregnancy or maternity.
Earlier this month the Trust held two days of mock CQC inspections as part of continuous improvement efforts. More than 70 members of staff, along with colleagues from NHSI/E and the CCGs, helped support clinical visits to 29 areas at PRH and RSH.
New bladder scanning equipment
During the event there was some excellent practice witnessed and evidence of improvement.
Bladder scanning equipment that will improve the lives of men suffering with prostate cancer has been donated to RSH.
As to be expected, there were also some areas that need more attention. These include:
The scanner was donated by the Shropshire Prostate Cancer Support Group, and will allow staff looking after those going through treatment to safely and effectively measure bladder consistency without invasive testing.
• Documentation - please remember to complete all assessments and to date and sign them. • Medicines management - we need to work on compliance with medicines management.
“We’re therefore looking for people who would like to help us to improve the patient experience for individuals within these ‘protected characteristics’. “As a member of the Equality, Diversity and Inclusivity sub-committee, you would work with us to identify health inequalities and help us to develop action plans to tackle and resolve such issues.” For more information, or for an application form, please contact the Patient Experience Team by emailing sath.patientexperience@nhs.net or calling 01743 261000, extension 3032 or 2503.
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Improvements this month • Our Emergency Departments have introduced a People Link Board to communicate the department and organisational goals to colleagues and share the team’s great work
Women and Children’s
• Our Emergency Departments have also have introduced CQC Quality Improvement information boards.
• Our Delivery Suite has achieved 100% compliance in PReCePT and the administration of Magnesium Sulphate during Quarter 2 (2019/20). • PreCePT is a National Quality Improvement project, funded by NHS England, designed to reduce the incidence of cerebral palsy through improving the uptake of magnesium sulphate, which is given to mothers who go into early labour. It means that mums-to-be who go into early labour (before 30 weeks) are offered magnesium sulphate during their labour to help reduce the risk of cerebral palsy in their babies. The programme involves the training of all midwives and doctors working in maternity so that more women can be offered magnesium sulphate. • Quality Improvement and Information folders have been delivered to all areas within Maternity. This is a resource tool for providing quick and basic guidance on many ‘how do I?’ topics. For example: How do I arrange an emergency interpreter? Or: How do I access confidential support for myself any time of day or night? The folders have been subdivided into five sections: Safe, Caring, Effective, Responsive and Well-led.
received following the Never Event Seminar earlier this year. • Plans to minimise interruption in theatres are being rolled out. A range of posters will be displayed on theatre doors and corridors to remind non-clinical staff not to enter at any time, while another poster has been made for bleeps and mobiles to be left at Theatre Reception. This action has also been done in response to staff feedback from the Never Event Seminar. • We now have more than 75 Safety Champions, all of whom are named on the Scheduled Care Safety Wall – which can be found in the department and on the care group’s intranet page. Safety Champions are individuals who have been nominated by colleagues for speaking up for safety to ensure all our patients have the highest standard of care within the Trust.
Unscheduled Care
Scheduled Care • A ‘5 Steps to Safer Surgery’ video has been launched for use in the induction process for theatre staff. The video is available to view on the Scheduled Care Safety and Governance intranet pages. The video has been made in response to the feedback
• The Unscheduled Care Group has introduced a weekly newsletter to keep the teams up to date. The newsletter shares recruitment updates, good news stories, how clinicians can learning from complaints, as well as updates from the care group’s governance meetings.
Workforce
• A free 24/7 support service has been introduced for staff to recognise the ever increasing pressures at work and home. Care First is an independent, leading provider of professional employee support services. They employ professionally qualified counsellors and information specialists who are experienced in helping people to deal with all kinds of practical and emotional issues such as wellbeing, family matters, relationships, debt management and workplace issues. • More staff than ever before are successfully completing their statutory and mandatory training (pictured). The Trust has a target of 90%+ and in October 2019 we reached our highest ever figure of 88%. This is despite the extra requirements added to ensure the safety of our patients and staff. As examples of our improvement, since September 2018, Adult Safeguarding compliance (level 2) has risen from 60% to 88% and Safeguarding Children (level 2) from 62% to 89%. Many staff members prefer to complete knowledge updates via e-learning at a time convenient to them and their service and this has been enabled where appropriate.
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Trust welcomes decision of In Panel to move forward with SaTH has welcomed a decision to move forward with plans to transform hospital services for the people of Shropshire, Telford & Wrekin and Mid Wales. Matt Hancock, Secretary of State for Health and Social Care, this month accepted advice from an independent panel of experts that the reconfiguration of PRH and RSH through the NHS Future Fit scheme, should be allowed to go ahead. This landmark decision will result in better care for patients, secure the £312 million from HM Treasury and develop both hospital sites to deliver state-of-the-art facilities in which staff will be proud to work and patients will choose to be treated.
Paula Clark Interim Chief Executive
Paula Clark, Chief Executive at SaTH, said: “This is great news for our Trust, but most importantly for the patients we serve across the whole of Shropshire, Telford & Wrekin and Mid Wales and for our staff, who have been waiting for this decision for many long years. “The Independent Reconfiguration Panel visited the county to speak not only to our clinicians, but also to those who have objected to the plans, and they have made it clear that the proposals that have been put forward should go ahead without further delay. That was the unanimous verdict of all members of the panel.” In its advice, the independent panel said: “The opportunity to visit the services and test the evidence with those involved locally served to reinforce the written evidence about the case for change. “Even if the ever-present problems of recruiting clinical staff to achieve safe rotas were resolved, the current model of emergency services provided through the two hospitals compromises safety and quality.
“The Panel heard frequently from the clinicians responsible for delivering these services that this is a daily concern and drives their advocacy for a new model of hospital care which will provide what the population currently does not get – access to consistently safe, high-quality emergency care and treatment 24-hours-a-day, seven-days-a-week.” The panel’s advice comes with a number of recommendations, including that “the urgent care model should enable as much clinically appropriate care to be delivered at PRH as possible. Options for diagnostics, ambulatory emergency care and frailty assessment must be considered”. This is something the Trust has supported all along and will continue to explore through the development of its Outline Business Case and Full Business Case.
Andrew Tapp Medical Director for the Hospitals Transformation Programme
Mr Andrew Tapp, Medical Director for the Hospitals Transformation Programme at SaTH, said: “This is great news and means we can now move forward to provide better care for our patients who require emergency treatment and planned operations. “Our hospitals serve more than half a million people and we owe it to them to provide the very best services possible. The reconfiguration of PRH and RSH will allow us to address the difficulties created by our current clinical set up and estate and resolve the continuing problems of staffing and recruitment. “There is still a long way to go, and our Hospitals Transformation Team will be working hard with clinical and estates teams across the Trust to make sure we get the best possible outcome from the huge investment in our health service in Shropshire and Telford & Wrekin.”
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ndependent Reconfiguration NHS Future Fit plans Ed Rysdale A&E Consultant
Ruth Smith Patient Experience Lead
Dr Ed Rysdale, an A&E Consultant at SaTH, said: “This is excellent news and I am excited about getting further involved in the re-design. It’s about making sure we create the right services for our patients – this means having a first class emergency department and planned care facilities.
Nurse Ruth Smith, who leads Patient Experience at SaTH, said: “Having specialist emergency care consolidated and delivered at a single site to treat acutely ill and injured patients will ensure that clinicians with specialist skills are available to meet the needs of patients.
“The reconfiguration plans have been clinically led from the start and the time has now come for us to get on and do it.”
“The decision will have a positive impact upon improving patient outcomes and experience as we will now be able to provide a safer, kinder and more effective service at the time this is needed most.
Chris Mowatt Consultant Anaesthesia and Intensive Care Foundation Year One Training Programme Director
Dr Chris Mowatt, Consultant Anaesthesia and Intensive Care Foundation Year One Training Programme Director, said: “The vision, very clearly, is two thriving hospitals which work for everyone. This will mean changes on both sites but it should not be seen as bolstering one at the expense of the other. “Creating improved provision for planned care means that patients are more likely to get the operations they need, on time and organised in a smooth, efficient way. Reconfiguring services to streamline care will help patients know what to expect and create better hospitals as we move towards the future. “The doctors, nurses and hospital management that have worked on Future Fit live and work in communities served by the Royal Shrewsbury and Princess Royal hospitals. It matters to all of us that we have a good local NHS and that we make things better for everyone wherever they live.”
“This is a great opportunity to work together with patients, their carers and the community in a collaborative approach to the development of services to ensure that they are planned around the needs of the patient.”
Mark Cheetham Consultant Colorectal Surgeon
Mr Mark Cheetham, Consultant Surgeon at SaTH, said: “The future model of care has clear advantages, it will provide better care and better results for our patients – and ensure that our two hospitals can continue to serve the people of Shropshire, Telford & Wrekin and mid Wales for a long time to come. “It is now time to put past issues behind us and work with the people of Telford & Wrekin, and all other interested parties, to develop urgent care services at PRH.”
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FLU 2019
It’s that time of year again when we turn our attention to flu—and doing all we can to prevent it from coming into our hospitals. SaTH launched its flu campaign on October 7 and jabbed more than 900 members of staff within the first week. The aim is to protect at least 80% of staff but it is not just about meeting targets, it is about protecting yourself, your family, your colleagues and of course our patients - particularly those that are the most vulnerable. And this campaign we will be saying thank you to everyone who has the flu jab by gifting you a £3 Caffé Bistro voucher. This can be redeemed at the outlets based in RSH and PRH. Don’t let Flu become the number one hit this winter! For further details, please visit intranet/flu
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#WE WIL
L ROCK FLU
Make sure you pick up your £3 Caffé Bistro voucher with every flu jab
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Learning from Excellence Awards were introduced in our ITU Departments to work in parallel with to learning when things go wrong. Learning from when things go wrong is of course incredibly important, but so is learning from colleagues in other departments who are perhaps doing something that could allow you to provide better patient care. You can also nominate a colleague from anywhere across the Trust by completing a form, which is available from ITU on both sites, and posting it through their Golden Letter Box. Alternatively, complete a form on the intranet via Clinical Services and Scheduled Care Safety. Pictured, from top to bottom, Adult Nursing Student Amy Gwilliam was nominated for excellent teamwork and showing initiative; Outreach Sister Caroline Houghton was nominated for excellent management of a challenging situation; Staff Nurse Sabina Jones was nominated for organising team building events. Sarah Kennerley, ITU Sister, was nominated for exceptional teamwork and management of a difficult situation;
Small Things Makes a Big Difference The Small Things Make a Big Difference Fund panel met this month discuss the most recent bids made. Money in the Fund can be bid on by all members of staff to improve your working environment. The panel awarded money for the following: • A fridge for Wards 22 and 28 • A microwave for Ward 25 • Vouchers for SaTH Little Helper for the Temporary Staffing Dept • 12 fans for the ophthalmology department • 8 fans for Ward 10 • A picnic bench for the Corporate Governance department • A picnic bench and potted plans for the Plaster Room • A picnic bench for House 3 • Pictures for the wall in the Breast Imaging Department The panel, which is always chaired by an Executive, has four core members who are joined by Staff Engagement Champions. To bid for funding from the Small Things Makes a Big Difference Fund, please visit http://intranet/Charity/lottery.asp All bids need to demonstrate how the funding will improve the working conditions of staff. The panel dates for the remained of the year are 15 November and 10 December.
Learning from complaints Complaint: Procedure was cancelled at the last minute
Complaint: Lack of reception staff and lack of clarity about clinics
Complaint: Patient information sent to offsite laundry
Cause: A difference of opinion in relation to risks of post-op bleeding
Cause: Reception staff hours do not cover all clinics
Cause: Information was caught up in linen when it was removed from bed
Action taken: Departmental protocol to be drawn up to give clear pre-operative guidance
Action taken: Clearer signage in waiting area and clinic HCA to maintain active presence in waiting area
Action taken: Staff made aware of breach and the need for vigilance when removing linen
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Trailblazing ACPs The Advance Clinical Practitioner (ACP) team held a clinically-focused conference at the end of September, led by Trust Lead ACP Emma Jones. The event attracted over 120 delegates from within the Trust, as well as visiting delegates from as far as Cornwall. Emma said: “SaTH started the journey with ACPs over five years ago with the first trailblazers of these roles in AMU and A&E. The Trust now has 35 ACPs across ED, AMU, Critical Care, Surgery, MSK, Frailty and Paediatrics.” Dr Amruta Lacy-Colson, Dr Dodiy Herman and Emma Jones developed the ACP programme at SaTH and have since introduced a local clinical training programme that enhances the Masters in Advanced Practice to ensure the Trust has robust and well trained non-medical clinicians for our future. Emma added: “These innovations have provided a clinical career path for nurses and allied-health professionals to remain in a clinical role while continuing to develop autonomous clinical skills and decision making, but also influencing and transforming our clinical services to improve patient care.”
Specialist Tracheostomy Practitioner A specialist Tracheostomy Practitioner has enhanced our nursing teams. Elaine France officially took up the new role on October 1 to enhance the service currently provided to adult patients with tracheostomies. Elaine will play a key role in providing specialist advice, guidance and support to patients, families, carers and all clinical staff who care for adult patients with tracheostomies. A tracheostomy is a medical procedure — either temporary or permanent — that involves creating an opening in the neck in order to place a tube into a person’s windpipe to allow air to enter the lungs. Elaine, who qualified as a Physiotherapist at Keele University in 1999 and has worked at SaTH for the past 19 years and initially worked within General Surgery before specialising in Critical Care and Head and Neck, said: “My aim is to ensure SaTH delivers a high quality, safe and effective service from insertion, daily care, to weaning and, where possible, de-cannulation. “I am delighted to have been accepted into this role and I intend to building positive relationships within the multi-disciplinary teams and wider health community to encourage a team approach. This will ensure the best outcomes for our patients, while ensuring staff feel confident and competent and that their clinical opinions are respected.” Clare Marsh, for Head and Neck services at SaTH, said: “Elaine will be a huge asset to the Trust as we look to improve this service. She has a longstanding interest in tracheostomy management and was part of our original tracheostomy action group “She will provide a vital link between all multi-disciplinary teams, departments and the wider health community, and will work across PRH and RSH where she will be actively involved in teaching, mentoring and assessing clinical and medical staff.”
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Improving understanding of mental health issues SaTH is working with a local mental health activist to improve understanding of mental health issues affecting patients using our hospitals.The conversation was started by Lynda Jones, an independent activist who has worked with a number of organisations across the region to highlight mental health. Lynda helped to establish, and co-chaired, a Mental Health Huddle at SaTH through our Kaizen Promotion Office. The huddle, which was supported by Bev Tabernacle, Deputy Chief Executive, was held at RSH with a video link to PRH and included input from bodies such as Telford MIND. Items discussed included:
• Are there too many assumptions around front door mental health care at SaTH? • What could be barriers and risks for staff and patients? • Education Following these initial discussions, there will now be a focus on five stand-out areas. Lynda said: “Since around 2015 the phrase ‘parity of esteem’ (valuing mental health equally to physical health) has been written and spoken about a lot. However from talking to individuals with mental health conditions who have attended both PRH and RSH, and staff from both hospitals, the perception was that, in practice, not much seemed to be happening to make parity of esteem a reality. As an Independent mental health activist I thought I would see if I could get the ball rolling. “Through Twitter, I had already built up a rapport with many staff from SaTH who were interested in the work I do, acknowledging my openness about my own past mental health issues. After a couple of informal meetings with the Transforming Care Team we all agreed to kick start discussions around mental health with the Mental Health Huddle. “It was very well received with individuals from Healthcare Assistants and Nurses, Consultants, to the Deputy Chief Executive participating. From the feedback received and discussions afterwards, it became clear that dealing with mental health conditions within the acute setting of SaTH needed appropriate training within that specific area. “Following our first huddle, I got together with Julia Clarke, Director of Corporate Governance, and other representatives from the Trust – appropriately enough on World Mental Health Day – to discuss our next steps. So watch this space.”
SaTH supported Freedom to Speak Up (FTSU) Month throughout October, a national campaign that calls on NHS organisations to increase awareness of how staff can raise concerns at work. SaTH has three FTSU Guardians: Kate Adney, Chan Kaur and Teresa Carrington, who cover all sites across the Trust. The Executive Lead for Freedom to Speak Up is Dr Arne Rose, SaTH’s Medical Director. In addition to SaTH's three Guardians, there are also 36 FTSU Advocates. Advocates work on a voluntary basis and can provide informal and confidential guidance on how to raise a concern. The FTSU team supported Freedom to Speak Up Month in a number of ways: • Awareness stands outside the canteens at both hospitals • Junior Doctor drop-in sessions • Advocates packs containing branded bags, pens, coffee mugs and a number of tools to help raise awareness of FTSU were distributed. Kate Adney, FTSU Guardian, said: “We are proud to have three FTSU Guardians and nearly 40 Advocates at SaTH. Our growing numbers show a real commitment to the wellbeing and safety of our staff and patients.”
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Louise appointed as new Chief Executive Louise Barnett has been appointed as the Chief Executive of SaTH. Louise, who will start in February, is currently the Chief Executive at The Rotherham NHS Foundation Trust, having joined them as interim Chief Executive in October 2013, prior to being appointed to the substantive position in April 2014. She has previously held a number of NHS board positions, including Interim Chief Executive, and Director of Human Resources and Organisational Development at Peterborough and Stamford Hospitals NHS Foundation Trust and Non-Executive Director at Sherwood Forest Hospitals NHS Foundation Trust. Announcing the appointment, Ben Reid, SaTH Chair, said: “Louise’s impressive track record of leadership and stakeholder engagement, along with her values and commitment to patients and staff, will provide inspirational leadership to the Trust. “I look forward to working with Louise and I am sure she will receive a warm welcome and support from teams across the Trust when she starts with us.” Louise said: “I am delighted to be taking on the role as Chief Executive and looking forward to working with staff and stakeholders to provide high-quality care and services for the local population.”
Nearly 180 new nurses joining SaTH Nearly 180 new nurses are to join SaTH to help improve the quality of care for patients.The 176 nurses have been recruited by the Trust from India to work at RSH and PRH. They will start to arrive in the country from December. The Trust has looked to overseas recruitment, through Health Education England’s (HEE) Global Learners programme, to help fill gaps in its substantive nursing and midwifery workforce. Rhia Boyode, Acting Workforce Director at SaTH, said: “Our teams are working incredibly hard to boost our workforce and we are now planning for an intake of 176 nurses from India to help boost our substantive nursing workforce and reduce the reliance on agency staff.
“The HEE programme was implemented to meet the shortfall of over 270 Band 5 nursing and midwifery vacancies in the Trust and these appointments will help to improve the care we give to our patients. “HEE’s Global Health Exchange is working with healthcare providers globally to improve the quality and volume of the NHS workforce through global education and workplace exchanges. “Telford & Wrekin Council and Shropshire Council, the community and our other partners have also been fundamental to the success of this project, and we are very grateful for their contributions.” Rhia added: “Whilst we are not yet fully staffed with nurses at PRH or RSH, we do have a number of other campaigns that we are promoting within the Trust, and we are also continuing to recruit from within the UK and Ireland, most recently with a campaign in Dublin.” Barbara Beal, Director of Nursing and Midwifery at SaTH, who led on the recruitment campaign with Workforce colleagues, welcomed the news. She said that the new nurses would be arriving in Shropshire in three cohorts from December. Barbara said: “This is extremely good news for our patients and our staff, so it is very important that our nurses feel welcome and we are doing everything we can to ensure they feel at home when they arrive.
“Their arrival in cohorts also means that we can ensure that the standards of proficiency, education and training meet our high standards.”
Improving Together
Spotlight on... SaTH’s Delivery Suite has been awarded Diamond status as part of the Trust’s Exemplar improvement programme. The Delivery Suite becomes the fourth department at SaTH to be crowned with a diamond. To achieve Exemplar Ward status, the team on a ward or department must meet high standards in a number of key areas from caring, medicine management, leadership, nutrition and hydration to cleanliness, safety and record-keeping. Paula Clark, Chief Executive at SaTH, presented the team with their award, saying: “This is a wonderful achievement by a fantastic team who always go above and beyond.
“The patient experience is at the very heart of Exemplar, so this is fantastic news for our new mums.” Rachel Downes, Ward Manager on the Delivery Suite, said: “I am very proud of the whole team whose commitment to our women and their families is second to none.
“We are absolutely thrilled to achieve Diamond status, which is testament to the hard work put in by each and every member of staff who works on the ward.” The other departments at SaTH with Diamond status are: The Postnatal Ward at PRH, Critical Care at RSH and Critical Care at PRH. There are three levels of award – Silver, Gold and Diamond. The Trust has three Gold areas: Ward 16 Stroke/Rehab at PRH, the Neonatal Unit at PRH and Ward 4 Trauma and Orthopaedics at PRH.
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